Sommaruga Marinella, Angelino Elisabetta, Della Porta Paola, Abatello Mara, Baiardo Giacomo, Balestroni Gianluigi, Bettinardi Ornella, Callus Edward, Ciracì Chiara, Omodeo Ombretta, Rizza Claudia, Michielin Paolo, Ambrosetti Marco, Griffo Raffaele, Pedretti Roberto F E, Pierobon Antonia
Istituti Clinici Scientifici Maugeri IRCCS Milan, Psychology Unit.
Monaldi Arch Chest Dis. 2018 Jul 2;88(2):966. doi: 10.4081/monaldi.2018.966.
Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.
近期心血管疾病预防指南建议，针对心理社会风险因素采取多模式行为干预措施，对于出现临床上显著抑郁和焦虑症状的情况，应转诊至心理治疗。因此，意大利心血管预防、康复与流行病学协会（GICR - IACPR）的心理学家对心血管预防与康复（CPR）中心理活动的关键组成部分进行了综述。本研究的目的是基于疗效、有效性和可持续性，就CPR常规心理活动的最佳实践制定一份立场文件。所采取的步骤如下：i）对最新的国际指南和立场文件进行综述；ii）对循证文献进行分析；iii）对意大利一些参考心脏康复机构开展的心理服务进行定性分析；iv）根据英国国家卫生与临床优化研究所（NICE）关于焦虑和抑郁心理干预的指南，将CPR中的心理活动分为低强度或高强度。我们证实抑郁、焦虑、社会因素、压力、人格与疾病发生/转归以及冠心病之间存在关联。抑郁、社会因素与疾病转归之间的关联证据，在慢性心力衰竭中尤为明显。一些积极的心理变量（如乐观）与疾病转归相关。有证据表明心理活动对目前已纳入心脏康复范畴的“新”病症有影响：肺动脉高压、成人先天性心脏病、终末期心力衰竭、植入式心脏复律除颤器和机械心室辅助装置、体弱及高龄患者以及临终关怀。我们还报告了与护理人员相关的证据。专家组将循证心理干预分为：i）低强度（咨询、心理教育、自我护理、自我管理、远程医疗、自助）；或ii）高强度（个体、夫妻和/或家庭及团体心理治疗，如压力管理）。结果表明，心理治疗主要包括认知行为疗法、人际疗法和短期心理动力学疗法。当前数据进一步完善了CPR中可用于心理活动的工作工具，为干预措施的选择提供了明确方向，干预措施应基于证据且至少有最低标准。本文件为在CPR环境中工作的心理学家提供了关于新知识和新路径的全面更新。
